Building a residential treatment program for dually diagnosed women with their children.

The epidemic of drug and alcohol abuse in our nation impacts millions of women, mothers, and children. Addicted mothers with complex problems and numerous co-morbidities present unique treatment challenges. This intergenerational cycle of abuse and addiction is difficult to stop. Arkansas CARES (Center for Addictions Research Education and Services, referred to in this article as CARES) initially was created to treat addicted pregnant and postpartum women and their infants. CARES evolved into a residential treatment program for dually diagnosed mothers with their children. This paper is a synopsis of a presentation delivered at the North American Society for Psychosocial Obstetrics and Gynecology. It shares a glimpse inside the treatment program and lessons learned along the way in an effort to assist others who are interested in building treatment programs for addicted women with their children.

Constant observation practices in the general hospital setting: a national survey.

The authors conducted a national survey of 355 general medical/surgical hospitals to assess constant observation (CO) practices. The authors assessed overall use, expense, staffing patterns, funding strategies, and cost-saving interventions. Virtually all responding hospitals (N = 102) reported using some form of CO. Several hospitals reported significant decreases in CO expenditures after the implementation of cost-saving interventions (the largest annual decrease reported was $340,000). Cost-saving interventions included utilizing consolidated bed spaces, relocating patients near nursing stations, placing at-risk patients in bed enclosure devices, and regularly assisting patients to the toilet. In addition, less costly personnel were hired, and volunteers and/or patient family members provided CO (or were required to assist with the cost of CO). Finally, hospital staff were educated about the costs and the appropriate use of CO. They were also taught to recognize and effectively treat delirium.

Follow-up consultation billing and documentation.

Frequently, bills are not submitted for follow-up visits for patients who have been evaluated psychiatrically on medical-surgical services. There often is confusion regarding which procedure codes are most appropriate to use in billing. To help the consultant understand the documentation requirements for various procedure codes, information from several sources was synthesized and distilled. This paper should help minimize documentation errors and maximize reimbursement for clinical services. The authors have reviewed available billing choices, and clarified the documentation requirements for different procedure codes according to Medicare regulations.

How C-L services can comply with new HCFA guidelines.

A psychiatric consultation report form was developed to efficiently and accurately meet the stringent Medicare documentation guidelines that go into effect July 8, 1998. This form was designed for use in academic institutions where the consultation team includes teaching physicians, psychiatric residents, and medical students. Medicare has strict requirements regarding who may document each element of the consultation for billing purposes. These requirements were taken into account in the design of this form. Two academic consultation-liaison psychiatric services piloted the form and conducted internal audits to evaluate its usefulness. The accuracy of billing improved twofold at one site because the form facilitated rapid completion of details requisite to justify CPT codes of complex assessments. This saved considerable time and effort over the previous methods used to determine an appropriate level of billing. Critical information was documented more frequently, thereby meeting the documentation requirements more consistently. Instructions for use, criticisms, and cautions are given.

Instilling happiness into medical school. The University of Arkansas College of Medicine's Medical Student Mental Health Program.

The University of Arkansas for Medical Sciences (UAMS), College of Medicine's Medical Student Mental Health Services Program, initiated in 1992, has grown into a comprehensive, readily accepted service utilized by one out of four medical students during their matriculation. Students rely on the service to help them with a wide variety of issues and feel secure that their care is confidential.

The multisite field trial of the consultation-liaison psychiatry assessment instrument.

A multisite field trial was conducted at 11 institutions to test the clinical reliability of a 29-item consultation-liaison (C-L) psychiatry assessment instrument. Twenty-five raters viewed videotapes of two "trainees" conducting clinical interviews with a simulated patient. One trainee was a medical student, the other was a fellow in psychiatry. Raters completed the 29-item assessment instrument for each trainee. The mean value scores reflected the skill of each trainee. The medical student had a mean score of 1.93, whereas the C-L fellow had a mean score of 3.13 which parallels the expected level of skill for the two interviewers. Eighty-six percent of the items (25/29) had a standard deviation (SD) of less than 1.0. Each of the remaining four items (14%) had a SD minimally greater than 1.0. These results reflect clear wording of items with measurable parameters defined for assessing trainees' skills. The authors present different uses for the assessment instrument, including giving feedback to trainees regarding interviewing techniques and skills; setting "gold" and "lead" standards for clinical C-L interviewing skills; and training supervisors in evaluation using a standardized assessment instrument.